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Have you ever wondered how a medical provider looks at labs? What about how labs differ from state to state, region to region, or country to country? And where do reference ranges come from? If so, today’s post should help you out and explain how differently we look at labs compared to the conventional medical establishment in the U.S.
So, what are the basic labs you’d likely encounter during a regular checkup visit?
CBC – Complete Blood Count.
This test measures and quantifies the major cellular components that are in your blood like red blood cells, white blood cells, and platelets, and measures the hemoglobin which is the protein that carries oxygen in the red blood cell. It also measures the hematocrit or the percentage of blood occupied solely by the red blood cells. A differential is commonly ordered along with the CBC which measures the percentage of several different types of white blood cells, the size of the red blood cells, and the amount of hemoglobin contained within them. The differential assists in determining immune system activity and identifying different types of anemia.
CMP – Complete Metabolic Profile.
This test measures fasting blood sugar, kidney and liver function, protein status, and takes a quick look at electrolyte and mineral balances. This study is crucial in determining organ function status and identifying many differing types of metabolic abnormalities.
Lipid Panel.
This test measures the typical labs associated with your lipids or cholesterol. It most commonly measures total cholesterol, triglycerides, HDL, and LDL. Also typically reported is the total cholesterol to HDL ratio which reflects the balance of sub-components in the lipids.
Nutrient labs.
These labs differ widely from practice to practice but commonly include vitamin B-12 levels, vitamin D levels, iron levels, and magnesium levels. These nutrients and minerals are essential in overall systemic function of the body. Having optimal levels of vitamin D, for example, can improve heart health, dental health, lower extremity function, reduce the risk of falls and fractures, improve bone density, and help to prevent cancer. These labs are not commonly run in conventional practice.
Inflammatory markers.
Common tests in this category are the ESR (erythrocyte sedimentation rate), C-reactive protein, and homocysteine. These tests are non-specific tests to assess the amount of inflammation that is active in a person’s body. These labs are not routinely run in conventional practice, especially homocysteine.
Thyroid tests.
What doctors are typically assessing in the lab work up are the TSH alone, or TSH in combination with total T4. This provides a small peek into the function of the thyroid and endocrine system.
The next piece to discuss is reference ranges. Most people assume that the reference range is correlated with a range associated with optimal health. This is not necessarily true. In general, a reference range is determined by obtaining laboratory reports of medical samples from large populations of people in certain geographic areas. The reporting institution or organization will first define the group of people who will be in the reference range based on the categories mentioned previously (age, gender. race, etc.). Then they will statistically average the results and decide how many standard deviations from the average in both directions will make up the range.
Interestingly enough, if you are a medical clinician in the panhandle of Texas and you want to evaluate a fasting glucose level, you will get the reference range somewhere in the 65-99mg/dL space. Now, if you go to Mississippi, this same reference range (according to University of Mississippi Medical Center) is 74-106mg/dL, and I have seen fasting glucose reference ranges in this part of the country as high as 80-139. So, are the people in Mississippi different that the people in the panhandle of Texas? The answer is unfortunately yes, they are more likely to be diabetics, hence the change of the reference range.
I commonly tell my patients/clients to go to the mall or another location where society seems to gather in mass, and just advise them to look around at all the people and make a judgement call regarding whether or not society seems to be healthy. Of course, I already know the answer based on reported medical facts. Here are some of them:
1) According to the CDC, as of 2017-2020, 41.9% of adult Americans are obese. Not a little overweight, but obese.
2) Obesity related conditions include heart disease, stroke, type 2 diabetes, and cancer. To drive this point home, heart disease, cancer, and type 2 diabetes are the 3 leading causes of death in America.
3) Also according to the CDC, as of 2017-2020, 19.7% of children aged 2-19 were obese. This is horrible for our country, and is also related to the fact that while we used to see things like Type 2 diabetes, and dementia as diseases of the aged, we are now seeing that juvenile onset type 2 diabetes is actually not all that uncommon in obese children, and we are just now starting to see juvenile onset dementia as the American diet continues to decline.
I could make that a much longer list with concerning health statistics according to our health agencies, but I don’t want to belabor the point. The lab reference ranges are greatly skewed by the unhealthy state of our population. This is why I use functional reference ranges that reflect health and not averages of a population.
It gets worse. As we have been advised nationally to eat a low-fat diet which varies from the historical diet that was reflective of health, how does this affect our vitamin levels if we want to check them? Well, there is plenty of research that has been done which reveals how important fats are in our diet, and saturated fats that come from healthy animals are some of the most vilified and also important among them. So what does this do to our lab reference ranges? Here I am just speculating, but feel that I am logically on the right track. Low fat diet equals low uptake of fat-soluble vitamins. So, vitamins A, D, E, and K. We are taught in medical school to avoid supplementing with these vitamins to prevent the dreaded “vitamin toxicity” associated with over-supplementing. At this point in my career, I have seen dozens of folks with Vitamin D levels far exceeding the recommended reference range of 30-100 (one person in the 180’s), and have never seen anyone who l would consider to have vitamin D toxicity. However, based on the fat-soluble vitamin toxicity ruse, the maximum suggested daily recommendations for Vitamin D top out at 4,000 IU, and here is where the art of medicine enters. For the past decade, I have supplemented most patients/clients at a minimum of 10,000 IU which is what it takes to get the vitamin D level up to over 55, which is the level shown by modern (post-pandemic) research to be the minimum needed to reduce your risk of infection or serious disease from epidemic or pandemic viral illnesses. Now, from my clinical experience, most people are around 30 or below if not supplementing and 4,000 IU’s daily is not enough in those situations to get the levels to 55 or above.
So, this is the medical situation we find ourselves in concerning labs. Reference ranges don’t reflect health. Period. It’s important that we not understand averages, but that we understand health. The conventional medical complex in our country has basically gone “All in” on allopathic medicine, which doesn’t seek to find cause, but rather to identify symptoms and then treat them. Bad reference ranges make even this unbalanced approach more perilous for the patient, as they will likely decline further, with their “dis-ease” progressing unnecessarily before being treated. For this reason, I don’t just check the simple labs above when I am trying to help figure out complex health conditions. I check A TON of them to get a good feel for the “terrain” of the person. Also, for this reason, I don’t typically go by the posted allopathic reference ranges as they do not correspond to health. I use my own functional reference ranges that DO reflect health.
And don’t even get me started on cholesterol… I think that deserves a post of it’s own.
I hope that this post finds all of you well. I pray that God blesses you, your health, and your families as we embark into 2023, together.
Micah – Worldview Wellness